Snoring and Sleep

Snoring is estimated to affect 57% of men and 40% of women in the United States. It even occurs in up to 27% of children.

These statistics demonstrate snoring is widespread, but its severity and health implications can vary. Snoring can be light, occasional, and unconcerning, or it may be the sign of a serious underlying sleep-related breathing disorder.

Knowing the basics about snoring — what causes it, when it’s dangerous, how to treat it, and how to cope with it — can facilitate better health and eliminate a common cause of sleep complaints.

What Causes Snoring?

Snoring is caused by the rattling and vibration of tissues near the airway in the back of the throat. During sleep, the muscles loosen, narrowing the airway, and as we inhale and exhale, the moving air causes the tissue to flutter and make noise like a flag in a breeze.

Some people are more prone to snoring because of the size and shape of the muscle and tissues in their neck. In other cases, excess relaxing of the tissue or narrowing of the airway can lead to snoring. Examples of risk factors that contribute to a higher risk of snoring include:

• Obesity
• Alcohol consumption
• Use of sedative medications
• Chronic nasal congestion
• Large tonsils, tongue, or soft palate
• Deviated septum or nasal polyps
• Jaw that is small or set-back
• Pregnancy

Though people of any age, including children, can snore, it is more common in older people. Men snore more often than women.

What’s the Difference Between Snoring and Sleep Apnea?

Obstructive sleep apnea (OSA) is a breathing disorder in which the airway gets blocked or collapsed during sleep, causing repeated lapses in breath.

Snoring is one of the most common symptoms of OSA, but not all people who snore have OSA. OSA-related snoring tends to be loud and sound as if a person is choking, snorting, or gasping.

OSA disturbs sleep and often disrupts the balance of oxygen and carbon dioxide in the body. More mild snoring, often called primary snoring, occurs frequently but doesn’t provoke these other effects.

Is Snoring Dangerous?

Whether snoring is dangerous depends on its type, severity, and frequency.

• Light, infrequent snoring is normal and doesn’t require medical testing or treatment. Its main impact is on a bed partner or roommate who may be bothered by the occasional noise.
• Primary snoring occurs more than three nights per week. Because of its frequency, it is more disruptive to bed partners; however, it is not usually seen as a health concern unless there are signs of sleep disruptions or sleep apnea, in which case diagnostic tests may be necessary.
• OSA-associated snoring is more worrisome from a health perspective. If OSA goes without treatment, it can have major implications for a person’s sleep and overall health. Unchecked OSA is associated with dangerous daytime drowsiness, and serious health conditions including cardiovascular issues, high blood pressure, diabetes, stroke, and depression.

When Should You See a Doctor About Snoring?

Many instances of snoring are benign, but it’s important to talk with a doctor if there are signs of potential sleep apnea:

• Snoring that occurs three or more times per week
• Very loud or bothersome snoring
• Snoring with gasping, choking, or snorting sounds
• Obesity or recent weight gain
• Daytime drowsiness
• Lack of focus or mental sharpness
• Morning headaches and congestion
• High blood pressure
• Nighttime teeth grinding (bruxism)
• Frequent nighttime urination (nocturia)

If you have noticed any of these signs, it’s important to address the issue with a doctor who can determine if additional testing or treatment is necessary.

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How Do I Know if I’m Snoring When I Sleep Alone?

Unless someone else tells them, most people who snore aren’t aware of it, and this is part of why sleep apnea is underdiagnosed.

If you sleep alone, your best bet is to set up a recording device. It could be an old-school tape recorder or one of many smartphone apps, but the apps have the advantage of analyzing sound patterns for you to detect likely episodes of snoring. It’s best to record for multiple nights since snoring may not occur every night. That being said, apps do not aid in the diagnosis of OSA.

If recording isn’t in the cards, be on the lookout for other red flags related to disrupted sleep such as noticeable daytime sleepiness, fatigue, problems with attention or thinking, or unexplained mood changes.

What Treatments Can Help Stop Snoring?

Treatment depends on the nature of the snoring and the types of problems it causes.

For people with infrequent or primary snoring, treatment may not be necessary unless it is disturbing a person’s sleep or the sleep of someone they live with. In those cases, treatments tend to be simpler and less invasive. People with sleep apnea usually need more involved treatment.

Types of treatments include lifestyle changes, anti-snoring mouthpieces, mouth exercises, continuous, auto, or bi-level positive airway pressure (CPAP, APAP, or BiPAP) devices, and surgery. A person’s physician is in the best position to describe pros and cons of any treatment in their specific case.

Lifestyle Changes

Lifestyle changes can help stop snoring, and in some cases, other treatments may not be necessary. Even when other treatments are prescribed, lifestyle changes are often still recommended. Examples of these changes include:

• Maintaining a healthy weight: Being overweight or obese are critical risk factors for snoring and sleep apnea, so keeping a healthy weight can be an important step against snoring.
• Limiting use of alcohol and sedatives: Alcohol is a frequent promoter of snoring, and sedative medications can trigger snoring as well.
• Adjusting your sleeping position: Sleeping on your back makes it easier for your airway to become obstructed. It may take time to get used to a different position, but it can be a helpful change. Specialty devices may help, or some experts recommend sewing a tennis ball into the back of a shirt so that you can’t revert to sleeping on your back.
• Raising the head of your bed: Elevating the top part of your bed with risers, a wedge pillow, or an adjustable frame may reduce snoring. For this to work, it’s important to raise the whole mattress and not just use more pillows.
• Reducing nasal congestion: Taking steps to eliminate allergies or other sources of nasal congestion can combat snoring. Breathing strips that go over the nose may help open your nasal passages during the night, as well as internal nasal expanders.

Anti-Snoring Mouthpieces

An anti-snoring mouthpiece helps hold your tongue or jaw in a stable position so that it can’t block your airway while you sleep. There are two main types of anti-snoring mouthpieces.

• Mandibular Advancement Devices: These work by holding the lower jaw forward. Many are adjustable so that you can find a more comfortable and effective fit.
• Tongue Retaining Devices: These mouthpieces help hold the tongue in place so that it doesn’t slide back toward your throat.

CPAP is still considered the gold standard treatment for sleep apnea. However, while some people can wear a CPAP comfortably, others find the apparatus bothersome, especially if the machine is loud, or if the mask fits poorly. Custom-fitted oral appliances are often a good alternative for OSA patients who cannot tolerate CPAP. Mandibular advancement devices, specifically, have been shown to be effective with not only snoring, but in mild to moderate OSA as well.

Mouth Exercises

Slackening of the muscles around the airway makes it more likely for a person to snore. Exercises to strengthen the mouth, tongue, and throat can counteract this, building muscle tone to reduce snoring.

Anti-snoring mouth exercises have shown most effectiveness in people with mild snoring and usually must be completed daily over a period of two or three months.

Positive Airway Pressure Devices

Continuous positive airway pressure (CPAP) machines are one of the most common treatments for sleep apnea in adults. They pump air through a hose and a mask and into the airway, preventing it from being obstructed. Bi-PAP machines are similar but have different pressure levels for inhaling and exhaling. APAP machines are “smart” machines that vary the pressure as needed.

CPAP, BiPAP and APAP machines are often effective in resolving sleep apnea and associated snoring. You need a prescription to get these devices, and they must be calibrated to suit your breathing. For that reason, it is important to work with a sleep technician to get started with a PAP device.

Wearing a PAP mask may be uncomfortable at first, but most people get used to it and find that using the device noticeably reduces snoring and improves sleep.

Surgery

In adults, surgery is rarely the first-line treatment for snoring or sleep apnea, but it may be an option if other approaches are not effective.

One type of surgery, called uvulopalatopharyngoplasty, widens the airway by removing nearby tissue. Surgery can also address nasal polyps, a deviated septum, or other blockages of the nasal passages.

Other types of less-invasive surgeries have been developed, but to date there is limited evidence from clinical trials regarding their benefits and downsides.

How to Share a Bed or Bedroom With Someone Who Snores

One of the biggest impacts of snoring is on another person who shares a bed or bedroom with the snorer. Chronic snoring may interrupt their sleep and potentially create tension in the household.

Stopping snoring is obviously the most immediate solution, but it’s not always easily achieved. In that case, using earplugs may help a bed partner cope with snoring. A white noise machine, white noise app, or even a fan may help drown out the sound of mild snoring.